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Last updated: Sun, Aug 4, 2024
The following extended quote comes from the chapter on fibromyalgia in Wall and Melzack's Textbook of Pain:
Some physicians consider people with FMS to be difficult patients for whom therapy is rarely successful. This therapeutic nihilism is clearly counterproductive and can act as a self-fulfilling prophecy. With that attitude in common parlance, it may be not surprising that patients with FMS become defensive, reactive, hostile, and angry about how they are treated.
Although patients in acute pain are usually treated with sympathy, patients with chronic pain tend to be regarded with suspicion. The primary care physician may not initially consider FMS as an explanation for the patient's symptoms. A routine examination will be performed and a few screening laboratory tests and radiographs might be obtained to seek an explanation. No one would argue with that initial approach. Frequently, however, some minor degenerative or other non-specific changes, such as an osteophyte or a benign disc protrusion, will be found and offered as the cause of the symptoms without considering the whole picture. Attempts at treatment may involve the administration of analgesics that do not provide adequate relief. The patient and the doctor soon become frustrated and mutually disenchanted.
From the doctor's viewpoint, this outcome can provoke suspicion regarding the veracity of the patient: "Perhaps he/she is malingering, drug-seeking, or it is 'all in his/her head' and he/she should be sent to a psychiatrist." Feeling impotent and impatient, the doctor is not pleased to see the patient or field many worried questions. The result can be avoidance, passive aggression, and even open hostility toward the patient. [This will tend to be a very unequal conflict.] From the viewpoint of the patient, frustration and disappointment with uninspiring attempts at treatment can engender distrust and will often prompt self-referred consultation with a series of specialists. Not knowing how to read the symptoms properly, the patient will probably choose the wrong specialty field. [In this scenario, the doctor can't read the symptoms properly either.] The typical result will be more expensive tests performed as the patient's anxiety builds and the diagnosis remains in doubt.
The average number of medical disciplines consulted after the development of widespread pain was 5 and ranged as high as 14.1
This quotation I think is worth including at length because it documents a doctor's candid vision of patient relationships in the treatment of chronic pain. We must be grateful to our care providers. I personally can't imagine a lot of things that would be more fraying to me than to have to deal with one suffering, unhappy, and demanding patient after another for a thirty- or forty-year career, particulary if I could not offer a very satisfactory treatment. I believe that they pay a high personal price to provide us with treatment. I also believe that, being human, they take measures to reduce the emotional price they pay for being chronically around us. These measures, I believe, include counterproductive ones such as avoiding talking to us about our pain, avoiding talking frankly to us about our own conditions and prognoses, and asserting inappropriate perquisites in the doctor/patient relationship. Disappointingly I have not encountered an article in my research that discusses either the price that care providers pay or any of the "maladaptive" coping strategies that I have suggested are deployed by care providers.
If it were true that care providers found it stressful dealing with demanding or pleading patients whom they can't satisfy, they just might be motivated to question the reality of the condition, to attempt to downplay its seriousness, or to blame the condition on the patient. Similarly, they might be inclined to refer the patient to another specialty.